Sunday, February 12, 2017

Communication Between Doctors and Patients - Words Matter

Here’s a quote that readers will not readily recognize.

It is a pity that a doctor is precluded by his profession from being able sometimes to say what he really thinks.

I’ll share the origin of the quote at the post’s conclusion.  How’s that for a teaser?  I'll give you a hint below.

Author of the Quote as a Young Child

Physicians by training and experience are guarded with our words.  To begin, we are never entirely sure of anything, and we should make sure that we do not convey certainty when none exists.  This is why physicians rarely use phrases such as, I’m positive that..., I’m 100% sure…, there are no side-effects…

Because of the uncertainties of the medical universe, sometimes we sanitize our own concerns when we are advising patients and their families.  We may see an individual in the office with unexplained weight loss and a change in her bowel pattern.  While we may fear that a malignancy is lurking, we would be wise to keep our own counsel on this impression pending further study.  This patient, for example, may be suffering from a curable thyroid disorder. 

Words matter.  We all have heard how patients and families can dwell on one or two words uttered by a physician, who may have spoken at some length on a patient’s condition.  In these cases, the families may have inferred more serious news than the physician intended.  Doctors need to be mindful of this phenomenon when we are communicating.  Which of these messages would you prefer to receive on your voice mail?

“Please make an appointment to review your biopsy results.”

“Your biopsy results are benign.  Please make an appointment so we can discuss them further.”

On other occasions, physicians may opt to leave out certain words or suspicions.  Why unload anxiety on folks before the truth is known?  Additionally, not every patient wants the whole truth administered in a single dose.  These scenarios demonstrate the advantage that a physician has when he has an established rapport and relationship with his patient. 

Conversely, I don’t feel we are helping patients and their loved ones when we overly sanitize the medical situation in order to postpone an unpleasant physician task or to create hope that may not be realistic.  There’s a balance to be attempted, and I still struggle to achieve it. 

The quote that started this post was published 90 years ago, not by a doctor or a nurse.  I stumbled upon it when reading The Murder of Roger Ackroyd, one of the greatest works by the master of mystery, Dame Agatha Christie.


  1. Hi, Dr. Kirsch. I was happy to find your article in PainMedicine News. My own experience with colonoscopy is singular and only marginally alarming. My issue was not with the procedure, rather the anesthesia. When I told my MD about it, he said it was not possible. I was sedated. I was "awake" for the procedure...not uncomfortable at all. However, it was a full six weeks until I was able to gather my thoughts, use full memory and navigate through an ordinary day. I was inconvenienced, but happy as a clam. My spouse, however, was terrified. I have severe chemical sensitivities and adverse reactions to most pharmaceuticals, so I'm cautious about taking medications. Is it possible to open a doctor's mind enough to help them consider this situation...or should I search for another doctor who thinks more openly? I am a 70 year old woman. Otherwise very healthy. I have three years to find an alternate anesthesia.

  2. @unknown, while I cannot comment on your specific situation, in general terms you need to be comfortable with your physician. Prior to your next procedure, I would counsel you to have an advance appointment with your current physician or a new one so that your concerns can be addressed. If the gastroenterologist uses a nurse anesthestist, a brief meeting with this professional might also be helpful. The key is dealing with your issue in advance, not on the day of the procedure.